Repeated peribulbar injections of triamcinolone acetonide: a successful and safe treatment for moderate to severe Graves' ophthalmopathy.
OBJECTIVE
In this study, we aimed to evaluate the efficacy of peribulbar triamcinolone injections to treat inflammatory signs of Graves' ophthalmopathy (GO) in patients with moderate to severe GO and associated optic neuropathy (ON).


METHODS
Twenty-one patients with active GO [clinical activity score (CAS) > or = 4] and systemic thyroid disease under control were enrolled in this prospective pilot study. Peribulbar triamcinolone acetonide was injected in each orbit (42 eyes), in four doses of 20 mg at 2-week intervals. Ophthalmological examination including CAS evaluation, visual field, computerized tomography (CT) scan and digital photography were performed before and after treatment.


RESULTS
Twenty-one patients (11 with moderate disease, 10 with ON) were enrolled in this study and followed for at least 14 months. Initial mean CAS was 6.38 +/- 1.49, which dropped to 1.8 +/- 1.12 after 6 months of treatment (P = 0.01; mean difference of 4.57 +/- 1.56; range 1-8 score points). ON was diagnosed in 10 patients. Of these, 66% improved with peribulbar triamcinolone exclusively. A transitory increase in intraocular pressure in two patients was controlled with topic medication.


CONCLUSIONS
Peribulbar triamcinolone injections reduce the inflammatory signs of moderate GO, as measured by the CAS, and could also be used as an alternative treatment for ON. Randomized clinical trials are needed to compare the results of triamcinolone peribulbar injections to those of other treatment modalities.
Bordaberry
Marcela
M
Ophthalmology Department, Santa Casa Hospital, Porto Alegre, Brazil. mbordaberry@hotmail.com
Marques
Daniela L
DL
Pereira-Lima
Julio C
JC
Marcon
Italo M
IM
Schmid
Helena
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D049970:Graves Ophthalmopathy / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009915:Orbit; D010865:Pilot Projects; D011446:Prospective Studies; D019233:Retreatment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014794:Visual Fields / Q000187:drug effects
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide